Modifier RT
Instructions
Used to identify procedures performed on right side of body. Refer to Medicare Physician Fee Schedule database (MPFSDB) to determine if HCPCS modifier RT is applicable to a particular procedure code
Correct Use
When body contains a right and left anatomical part of body and a service is performed on right anatomical part
Incorrect Use
When a procedure code specifies bi-lateral or a side of body
Note: Modifier RT does not affect allowed amount on a claim; however, lack of modifier can cause denials or development to occur
Modifier 47
Anesthesia by Surgeon
Instructions
Surgical allowable based on 50 percent of Medicare Physician Fee Schedule (MPFS)
Correct Use
Regional/general anesthesia provided by surgeon/attending surgeon only
Append 47 modifier to basic surgical service/procedure only
Incorrect Use
Surgeon performs both surgery/anesthesia, separate payment not allowed
Anesthesiologist not covered with 47 modifier
Not appropriate with anesthesia codes or local anesthesia
Not appropriate with moderate sedation (99143 – 99145)
Not appropriate for monitoring general anesthesia provided by
Certified Registered Nurse Anesthetist (CRNA), intern, anesthesiologist or resident
Modifier 80
Assistant Surgeon
Instructions
Modifier 80 is appended to the surgical code when another surgeon is assisting at surgery. Check Medicare Physician Fee Schedule (MPFS) Indicator/Descriptor Lists. See Column A indicates if assistant at surgery allowed/not allowed.
Correct Use
Physician:
Assist-at-surgery allowed with appended modifiers 80, 81 or 82
Allowed = 16% of surgery fee schedule allowable
Note: Non Physician Practitioner (NPP) or mid-level practitioner (PA, NP, CNS):
Append AS modifier only
Allowed equals 85% of surgical assist or 16% allowable
Incorrect Use
Inappropriate to bill AS modifier for physician surgical services
Inappropriate to append modifier 58 (staging) with assistant surgery
Claim Coding Example
Per fee schedule indicator, descriptor 2 = payment restriction for assistants at surgery does not apply to this procedure. Assistant surgeon may be paid.
Treatment Description
CPT 43846 /Modifier 80
Gastric Bypass for Morbid Obesity
Modifier 81
Minimum assistant surgeon
Instructions
Modifier 81 is appended to the procedure code for an assistant surgeon who assists an operating or principal surgeon during part of a procedure. Check the Medicare Physician Fee Schedule (MPFS) Indicator/Descriptor Lists. Column A indicates if assistant at surgery is allowed.
Correct Use
Append to appropriate code when more than one assistant is involved or if one person assists during a portion of surgery. Includes physicians providing minimal assistance to primary surgeon. Must be used with Type of Service 8 codes.
This modifier identifies surgical assistant services
Indicates exceptional medical circumstances exist
Indicates primary surgeon has policy of never involving residents in preoperative, operative or postoperative care of his/her patients
Claim Coding Example
Fee Schedule Indicator Descriptor 2 = Payment restriction for assistants at surgery does not apply to this procedure. Assistant surgeon may be paid.
Treatment Description - Gastric Bypass for Morbid Obesity
Modifier 82
Assistant Surgeon – when qualified resident surgeon not available
Instructions
This modifier is used when minimal surgical assistance is needed, but a qualified resident was not available (documentation required). First, check Medicare Physician Fee Schedule (MPFS) Indicator/Descriptor List. Column A indicates if assistant at surgery allowed/not allowed.
Correct Use
Physician:
Assist-at-surgery allowed with appended modifiers 80, 81 or 82
Allowed = 16% of surgery fee schedule allowable
Modifier 82 needs a statement that "no qualified resident surgeon was available"
Indicates exceptional medical circumstances exist
Primary surgeon must have a policy of never involving residents in preoperative, operative or postoperative care of his/her patients
Non Physician Practitioner (NPP) or mid-level practitioner (PA, NP, CNS):
Append AS modifier only
Allowed equals 85% of surgical assist or 16% allowable
Incorrect Use
Inappropriate to bill physician assistant surgical services with AS modifier
Inappropriate to append modifier 58 (staging) with any assistant surgery
Claim Coding Example
Per fee schedule indicator descriptor 2 = payment restriction for assistants at surgery does not apply to this procedure. Assistant surgeon may be paid.
Treatment Description
CPT 55866 /Modifier 82
Laparoscopy, surgical prostatectomy
Modifier AS
Physician Assistant (PA), Nurse Practitioner (NP) or Clinical Nurse Specialist (CNS) assistant at surgery services.
Instructions
Append this modifier to appropriate procedure codes when Non-Physician Practitioners (NPPs) are assisting a principal surgeon as an assistant surgeon. The assistant at surgery provides more than ancillary services. NPPs include a CNS, NP and PA.
Correct Use
The Medicare Physician Fee Schedule (MPFS) Indicator/Descriptor lists under column A will confirm if assistant at surgery is allowed.
2 = payment restriction for assistants at surgery does not apply to this procedure. Assistant surgeon may be paid).
NPP, mid-level practitioner or advance practice practitioner (APP)
Append this modifier only
NPP must accept assignment
NPPs are allowed 85% of 16% physician fee allowable or 14% of surgery
Incorrect Use
Inappropriate for NPPs to use modifiers 80, 81 or 82 (physician only modifiers) Modifier 80 (assistant surgeon), 81 (minimum assistant surgeon) or 82 (qualified resident surgeon not available) with physician (MD/DO) assisting at surgery
Modifier AT
Acute or Active Treatment
Instructions
This Chiropractic only AT modifier tells Medicare that this treatment should be covered as acute or active treatment.
Correct Use
Chiropractic manual manipulation of the spine service for acute therapy Involves codes 98940, 98941 and 98942 only
Corrective treatment supporting the manipulation
Not considered Maintenance therapy (see modifier GA)
Documentation MUST support acute/active/corrective treatment
Incorrect Use
Do not bill modifier AT with denial modifiers (GA, GX, GY or GZ) on same line
Claim Coding Example
An established patient complains of upper back pain due to gardening.
Treatment Description
CPT 98941 /Modifier AT
Chiropractic Manipulative Treatment (CMT); spinal, three to four regions
Modifier GN
Services delivered under an outpatient speech language pathology plan of care
Correct Use
Submit modifier GN to indicate that the services were delivered under an outpatient speech language pathology plan of care.
If additional modifiers are required with the service, modifier GN must be submitted in the first or second modifier position.
Exception: Claims from physicians (all specialty codes) and non-physician practitioners, including specialty codes "50, 89, and 97", may be processed without therapy modifiers for sometimes only therapy codes.
If specialty codes "65" and "67" are on the claim and an applicable HCPCS code is without one of the therapy modifiers (GN, GO, GP), the claim will be returned as unprocessable.
Modifier GO
Services delivered under an outpatient occupational therapy plan of care
Correct Use
Submit this modifier with services that were delivered under an outpatient occupational therapy plan of care. If additional modifiers are required with the service, HCPCS modifier GO must be submitted in the first or second modifier position.
Modifier GP
Services delivered under an outpatient physical therapy plan of care
Correct Use
Submit this modifier with services that were delivered under an outpatient physical therapy plan of care. If additional modifiers are required with the service, modifier GP must be submitted in the first or second modifier position.
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